Climate crisis risks to elderly health: strategies for effective promotion and response

Abstract The climate crisis significantly impacts the health and well-being of older adults, both directly and indirectly. This issue is of growing concern in Canada due to the country’s rapidly accelerating warming trend and expanding elderly population. This article serves a threefold purpose: (i) outlining the impacts of the climate crisis on older adults, (ii) providing a descriptive review of existing policies with a specific focus on the Canadian context, and (iii) promoting actionable recommendations. Our review reveals the application of current strategies, including early warning systems, enhanced infrastructure, sustainable urban planning, healthcare access, social support systems, and community engagement, in enhancing resilience and reducing health consequences among older adults. Within the Canadian context, we then emphasize the importance of establishing robust risk metrics and evaluation methods to prepare for and manage the impacts of the climate crisis efficiently. We underscore the value of vulnerability mapping, utilizing geographic information to identify regions where older adults are most at risk. This allows for targeted interventions and resource allocation. We recommend employing a root cause analysis approach to tailor risk response strategies, along with a focus on promoting awareness, readiness, physician training, and fostering collaboration and benchmarking. These suggestions aim to enhance disaster risk management for the well-being and resilience of older adults in the face of the climate crisis.


INTRODUCTION
Climate change constitutes a crisis (Zeldin-O'Neill, 2019) driven by complex interplays of commercial (Arnot et al., 2023a;Gilmore et al., 2023), political (Yeganeh et al., 2020;Arnotet al., 2023;Arnot et al., 2023b) and social (Dankelman and Naidu, 2020;Klinenberg et al., 2020;Gislason et al., 2021) factors, demanding immediate attention and action.Commercial activities, particularly in the fossil fuel industry, significantly drive the climate crisis through mechanisms including supply chains, industrial processes, global trade, transportation and resource extraction (Gilmore et al., 2023).These sectors release substantial carbon dioxide, intensifying the greenhouse effect and global warming.Profit motives also fuel excessive consumption and hinder sustainability (Arnot et al., 2023b).Political determinants, like government regulations and international agreements, are vital for climate action but are often influenced by economic imperatives, necessitating urgent responses to the climate crisis.Social determinants emphasize societal factors (e.g.income, infrastructure) and behaviors (e.g.cultural practices) in the climate crisis (Ercan et al., 2022).
The climate crisis poses a significant threat to human health, with the World Health Organization (WHO) estimating an additional 250 000 deaths annually between 2030 and 2050 (WHO, 2014).It impacts human well-being both directly and indirectly.Direct impacts include increased mortality and illnesses caused by extreme climate events such as heat waves, storms, wildfires, floods and droughts.Indirect effects result from changes in ecosystems, economies and social structures, leading to the spread of disease vectors, waterborne pathogens and deterioration in air, water and food quality (Watts et al., 2015;Caminade et al., 2019).
The impacts of climate crisis on elderly people are particularly pressing in Canada due to several reasons.First, the impacts of the climate crisis on human health are significantly influenced by age, with older adults being at a higher risk of adverse effects (Fulop et al., 2010;Gamble et al., 2013;Perez et al., 2022).The situation becomes more complex due to the health inequalities related to the climate crisis concerning older adults, which primarily stem from disparities in vulnerability and resilience.For instance, a significant portion of older adults in Canada live alone (Statistics Canada, 2012), have disabilities (Arim, 2015), and suffer from chronic conditions (Carstairs, 2000), with many experiencing financial stress (Campbell and Keehn, 2018).Second, Canada is experiencing a faster rate of warming compared to the global average (Lewis and Dickson, 2019; Public Health Agency of Canada, 2019).Lastly, the older adult population in Canada is projected to increase from 15% in 2011 to 25% in 2036, posing a significant threat to the health of this vulnerable demographic (Statistics Canada, 2011;United Nations, 2017).
The above discussion underscores the importance of raising awareness and improving our understanding of how climate crisis affects older adults.This article has three main objectives: (i) to outline the direct and indirect effects of climate crisis on older adults, (ii) to provide a descriptive review of existing policies with a specific focus on the Canadian context and (iii) to propose recommendations to enhance current practices in mitigating the impacts of the climate crisis on older adults.

IMPACTS OF CLIMATE CRISIS ON ELDERLY HEALTH
In this section, we explore the impacts of climate crisis on older adults' health (Figure 1).The complication arises from health inequalities, placing older adults at a higher risk in the face of the climate crisis.This concern is increasingly recognized in health promotion and public health priorities (Thomas and Daube, 2023;Thomas et al., 2024).
Health disparities among older adults due to climate change stem from vulnerability and resilience factors.Aging reduces thermoregulation and weakens immunity, heightening risks during climate events.Socioeconomic disparities limit access to essentials like air conditioning and healthcare, hindering adaptation.Existing health issues worsen outcomes during heat waves and air pollution.Geographical factors in disaster-prone areas intensify health risks, compounded by sparse vegetation.Social isolation and limited information hinder preparation, while disabilities impede access.Intersectional factors like race, ethnicity, gender and sexual orientation exacerbate disparities.Minorities face higher risks due to socioeconomic gaps, and LGBTQ+ elders may face discrimination during disasters (Goldsmith et al., 2022).

Direct impacts
The climate crisis directly impacts human health, especially through extreme weather events like heat waves, floods, droughts and wildfires.These events pose significant health risks for older adults.The following sections will examine each of these impacts individually, focusing on Canada.

Extreme weather
The Earth experiences more extreme weather due to climate change, with rising heat waves and the potential for colder temperatures (Kim et al., 2017;Gibbens, 2024).In Canada, addressing heat wave-related risks is prioritized (Beugin et al., 2023), supported by significant warming in recent decades, with Canada warming at twice the global rate (Government of Canada, 2023).Canadians have adapted to extreme cold through physiological changes (Alberini et al., 2011;Haman et al., 2022), leading to concerns about increased heat-related mortality, especially in cities like Hamilton.Projected increases of 7%, 15% and 25% for 2031-2050, 2051-2070 and 2071-2090, respectively, compared to 2011 mortality rates, highlighting  the urgency of addressing heat-related risks (Martin et al., 2012).

Flooding
The heightened frequency and intensity of extreme weather events, such as flooding, pose significant risks to older adults.Direct consequences include death and injuries, while indirect impacts encompass mental health issues, waterborne illnesses and respiratory/ cardiovascular diseases (Shrubsole, 2013;Sahni et al., 2016;Pelletier, 2017).Flooding is expected to become a major climate-related threat in Canada, with 22 events from 2000 to 2015 resulting in 18 deaths and affecting 126 474 people (Burton et al., 2016).Older adults face health inequalities related to residential location and healthcare access, particularly in communities near water bodies (Shrubsole, 2013;Council of Canadian Academies, 2019).Their vulnerability is compounded by social isolation, limited awareness of flood risks, disabilities and reduced physical capabilities (Adams et al., 2011).These factors increase susceptibility to immediate dangers and exacerbate long-term health issues, including stress and mental health conditions (Sahni et al., 2016;Sands et al., 2022).

Droughts
Elevated temperatures from global warming exacerbate drought's impact on vulnerable groups, notably older adults.Severe drought is observed in southern Canadian Prairies and British Columbia's interior valleys.Research demonstrates that those aged 65 and older, particularly 75 and above, face heightened mortality risks from drought (Salvador et al., 2021(Salvador et al., , 2022)).This heightened vulnerability arises from a combination of disparity factors.Physiological changes associated with aging, such as weakened immune systems, make older adults more susceptible to waterborne and airborne diseases.Existing health conditions and medications can exacerbate these vulnerabilities, while social and economic factors like isolation and limited income can hinder their ability to adapt to drought conditions.Psychological impacts, such as stress and anxiety, further compound these challenges (Horton et al., 2010).Drought also has numerous indirect impacts on human health, including waterborne illnesses (Yusa et al., 2015;Hyllestad et al., 2020), airborne dust-related diseases (Stanke et al., 2013;Yusa et al., 2015), undernutrition and malnutrition (Lieber et al., 2022), mental health problems (Vins et al., 2015) and an increased risk of infectious and vector-borne diseases (VBD) (Yusa et al., 2015).

Wildfires
The climate crisis heightens the risk of wildfire ignition sources and the growth of flammable vegetation, resulting in around 8000 annual wildfires in Canada (EPA, 2021).In 2023, Canada experienced record-breaking wildfires, scorching an area larger than Greece (Milman, 2023).In Canada, older adults face heightened vulnerability to wildfires due to various health disparities.These include insufficient awareness of wildfire risks, often linked to limited access to timely and comprehensible information.Challenges during emergency evacuations are amplified by physical constraints, absence of personal transportation and social isolation.Wildfire smoke exposure significantly exacerbates health conditions, resulting in increased respiratory and cardiovascular ailments among older adults (Ye et al., 2021).Moreover, the stress and trauma induced by wildfires can trigger mental health issues, particularly anxiety and depression, among this demographic (DeFlorio-Barker et al., 2019;To et al., 2021).

Indirect impacts
The climate crisis has emerged as a significant global concern, with far-reaching indirect impacts on the health of older individuals.As we discuss below, these impacts have been observed and supported by compelling evidence, particularly in the context of Canada.

Vector-borne diseases
The climate crisis, resulting in elevated temperatures, has amplified Lyme disease (LD) occurrences in Ontario, Canada (Cheng et al., 2017), which may manifest as flu-like, arthritic, neurological and cardiac symptoms (Johnson et al., 2018).Older adults with less effective immune systems confront heightened LD susceptibility and suboptimal treatment outcomes (Boršič et al., 2018;Zomer et al., 2018).Furthermore, reported human infections of West Nile virus (WNV) notably surged from 2014 to 2018, with the highest incidence recorded in the Canadian prairie provinces (Chen et al., 2013;Public Health Agency of Canada, 2019).Severe WNV infections can lead to long-term physical issues, mental health issues, neurological diseases and death (Sejvar, 2014;Bai et al., 2019).In 2018, most of the 29 WNV-related deaths occurred among infected older Canadian adults (Public Health Agency of Canada, 2018).Socioeconomic and geographical disparities can worsen the effects of VBDs in older adults.Limited financial resources and healthcare access increase their vulnerability to severe health consequences.Rural or underfunded regions, which are at greater risk for disease exposure, often lack adequate medical resources for prompt diagnosis and treatment.These inequalities create a troubling cycle where older adults, who are already vulnerable due to weakened immune systems, face elevated risks and suboptimal treatment outcomes.

Water, air and food pollution
The climate crisis, with heavy rainfall and rising temperatures, negatively impacts water and air quality, straining Canada's water treatment systems (Chhetri et al., 2019).This increases the risk of waterborne illnesses among older adults.Proactive adaptation and strengthening of water systems are crucial to mitigate climate crisis-related health risks in this vulnerable group.
Disparities in infrastructure (e.g.outdated water treatment systems), healthcare access and socioeconomic status increase older adults' vulnerability to climate-related waterborne, air and foodborne diseases.These disparities, coupled with preexisting health conditions and weakened immunity, create a cycle of heightened vulnerability and poorer health.For instance, older adults, due to preexisting health conditions, face heightened vulnerability to air pollution (Simoni et al., 2015), resulting in various health issues, including respiratory problems (Lepeule et al., 2014), peptic ulcer bleeding (Tian et al., 2017), Alzheimer's disease (Wu et al., 2015), chronic kidney disease (Chen et al., 2018) and cardiovascular disease (Chuang et al., 2011).With the climate crisis, the mortality rate linked to air pollution is expected to soar, especially among older adults (Canadian Medical Association, 2008).
Climate crisis increases the risk of foodborne diseases through flooding and rising temperatures, impacting diseases like Campylobacter, Escherichia coli and Salmonella.Floods can contaminate fields with pesticides and animal waste, while higher temperatures expand disease-carrying wildlife vectors (Smith et al., 2019).In Canada, these diseases already affect millions, resulting in hospitalizations and deaths (Thomas et al., 2013).Older adults are especially vulnerable due to weakened immune systems, chronic illnesses, malnutrition, dementia and unsafe food practices (Lake, 2017;Smith et al., 2019).

REVIEW OF MITIGATION STRATEGIES AND ACTION PLANS
Efforts to minimize disaster impact on vulnerable populations are based on four pillars: prevention/ mitigation, preparedness, response and recovery (Field et al., 2012).Table 1 outlines existing disaster risk management policies for the elderly, addressing the direct and indirect impacts of the climate crisis.In the following sections, we will examine these policies and corresponding strategies for older adults.

Policy approaches to mitigate the impact of extreme weather
In Canada, the government has historically implemented measures to address cold-related challenges, including offering energy home grants to improve heating systems and reduce energy waste during winter.For example, the Government of Ontario's Energy Rebates program provides substantial incentives for energy-efficient practices, such as offering up to $325 for each high-performance window upgrade, with total rebates reaching $10 000.These initiatives aim to help Canadians deal with the challenges of cold waves during winter.However, it is crucial to acknowledge that while efforts to tackle cold-related issues are in place and actively promoted, the increasing threat of heatrelated deaths demands a renewed and robust response.
Effective heat-related condition prevention requires comprehensive emergency response plans.Identifying responsible agencies like public health and fire authorities, the Canadian Red Cross and Meals on Wheels is vital (Lubik and Kosatsky, 2017).Vulnerability mapping, considering factors like air conditioning availability and age demographics, identifies high-risk areas (Reid et al., 2009;Schmeltz et al., 2013).While air conditioning is crucial for elderly health during heat waves, acknowledging its sustainability challenges is essential (Prek, 2004;Grignon-Masse et al., 2011).Promoting energy-efficient cooling technologies and responsible air conditioning practices can address elderly needs while minimizing environmental impact.Implementing long-term measures like urban vegetation, heatresilient infrastructure and improved cooling access is crucial (Burkart et al., 2016;Taylor et al., 2018Taylor et al., , 2021)).Collaborative efforts of public health experts, urban planners and stakeholders are vital to mitigating urban heat islands in Canadian cities (Health Canada, 2020).
To enhance heat wave preparedness and response, effective communication and public education are vital (Singh et al., 2015).This includes promoting individual actions like increased fluid intake and reduced physical activity (Dotto et al., 2010).Community measures such as opening cooling centers, extending pool hours and providing heat warnings are essential.Activation and deactivation criteria based on humidity and temperature triggers are crucial (Lubik and Kosatsky, 2017).While Canada has heat alerts and response systems, their effectiveness for older adults with impairments needs evaluation.Poorly coordinated responses to extreme weather harm vulnerable populations (Benevolenza and DeRigne, 2019).
Effective recovery measures are therefore crucial, including medical care, monitoring and social support (Benevolenza and DeRigne, 2019).Healthcare professionals can provide necessary treatments, while community outreach and volunteers provide emotional support, combat isolation and connect older adults with essential resources during heat waves.

Policy approaches to mitigate the impact of flooding
To mitigate flood impacts, emergency plans must consider health inequalities affecting older adults, including their health status, access to healthcare, transportation and the potential for increased hospital visits (Burton et al., 2016).Unfortunately, over 25% of Ontario hospitals lacked disaster risk management mechanisms (Seeman et al., 2008).Therefore, a robust mitigation strategy, which may include land use planning, flood mapping and warning systems, collectively helps reduce flood impacts (Government of Ontario, 2020).For example, effective land use planning may recommend increased vegetation to enhance water absorption capacity, thereby reducing runoff and the risk of flooding.
The 2013 Alberta floods revealed insufficient flood preparedness, emphasizing the need to enhance readiness (Austin et al., 2015).This involves training older adults and caregivers, bolstering caregiver capacity and stockpiling vital supplies.Such measures are vital as floods can disrupt crucial services and access to necessities (Yodsuban and Nuntaboot, 2021).
Evacuating older adults during floods often neglects their specific needs, emphasizing the importance of equitable response measures (Bukvic et al., 2018).This entails prioritizing accessibility and appropriate infrastructure for those with mobility challenges (Ashida et al., 2016;Brockie and Miller, 2017).Incidents like seniors encountering deep waters in Ottawa (Westwood, 2017) and discomfort in crowded facilities in Calgary (Muscedere and Heckman, 2019) highlight the necessity for coordinated resources, information sharing and partnerships among government agencies, healthcare providers and community groups.
Financial concerns affect approximately 50% of Canadians aged 60 and over (Campbell and Keehn, 2018).Therefore, in disaster recovery planning, prioritizing psychological and designing targeted financial support is crucial (Thompson et al., 1993).To address this, governments should provide financial aid to seniors affected by disasters like floods.For instance, the Ontario government has recently pledged support to flood victims, emphasizing the importance of such aid for seniors' recovery (Government of Ontario, 2020).

Policy approaches to mitigate the impact of drought
The primary preventive and mitigation strategies to combat drought involve vulnerability assessment and water resource management, including rainwater harvesting and reservoir construction (Gautam and Bana, 2014).Collaboration among stakeholders, including farmers and water management agencies, is crucial to develop integrated drought management plans.Promoting drought awareness among stakeholders, including farmers, is vital, alongside physical preparedness measures and educational programs about sustainable water use, drought-resistant farming and conservation (Gautam and Bana, 2014).In addition, early warning systems and risk assessments empower communities for preparedness (Nhamo et al., 2019).Responses include promoting water conservation and enforcing use restrictions through education campaigns (Yusa et al., 2015).Initiatives like the Invitational Drought Tournament in British Columbia aim to manage drought impacts through monitoring, education and mental health programs (Hill et al., 2014).Health monitoring systems for older adults during drought are crucial, including access to medical care and guidance on managing heat stress.Recovery plans should involve establishing drought response teams, securing funding and fostering coordination among government agencies, healthcare providers and community groups (EPA, 2016).

Policy approaches to mitigate the impact of wildfire
To mitigate wildfires, regulations should minimize human-induced fires, utilizing resource allocation, fire permit restrictions and equipment rules.Decision support tools are, therefore, essential for efficient wildfire management (Tymstra et al., 2020).Educating older adults about creating defensible spaces by removing flammable materials and maintaining vegetation is also critical in wildfire mitigation.
Educational initiatives play a pivotal role in preparedness plans by raising awareness among older adults about wildfire risks and health consequences.For instance, recent guidelines in the United States advise seniors to maintain essential supplies, including medications, N95 masks and portable air cleaner filters (HomeInstead, 2023).Social cohesion has been shown to enhance resilience to wildfires, ultimately reducing their health effects (Prior and Eriksen, 2013).
An effective wildfire response strategy necessitates comprehensive education, including outreach programs and educational materials for older adults about wildfire risks, evacuation protocols and early detection.Encouraging them to create evacuation plans, identify routes, prepare emergency kits and establish communication networks with family, neighbors and authorities is crucial.
The recovery strategies are essential to restoring the emotional, financial and physical well-being of older adults affected by climate change disasters (Rosenthal et al., 2021).Strategies include postdisaster counseling, support groups and mental health services for emotional and psychological impacts.Financial assistance aids in home repairs, insurance claims and accessing benefits.Community engagement and volunteer efforts assist older adults in rebuilding and resource access (Corbin et al., 2021).

Policy approaches to mitigate the impact of VBDs
Climate change exacerbates existing inequalities, including those resulting from economic injustice (Islam and Winkel, 2017).Poverty, inadequate housing and poor environmental conditions increase vulnerability to VBDs, especially among children, women and older adults (Sutherst, 2004;Thomson and Stanberry, 2022).Targeted financial support for surveillance and control is, therefore, an essential preventive measure to enhance public awareness, detection, prevention and treatment of VBDs (Organization, 2019).Financial support for community-based strategies is also crucial, involving public policies regulating land use and construction, as well as surveillance for vectors and disease incidence.Early warning systems can improve surveillance effectiveness, facilitating prompt response measures such as public awareness campaigns (Thomson and Stanberry, 2022).Other preventive measures include monitoring tick distribution, effective tick habitat management and personal protective measures (Harymann et al., 2014;de la Fuente, 2018;Eisen, 2018;Moon et al., 2019;van Steen et al., 2019;Bron et al., 2020).
Increasing public awareness of tick-borne diseases is vital for enhancing preparedness to facilitate timely testing and pathogen identification (Scott and Scott, 2018;Hornbostel et al., 2021).Response actions for individuals diagnosed with LD involve diagnostic tests and treatment, as there is currently no specific vaccine available for WNV (Rantakokko et al., 2013;Harymann et al., 2014;Johnson et al., 2018).The recovery options for older adults facing VBDs include health monitoring, rehabilitation services, such as speech therapy, occupational therapy, or cognitive rehabilitation, pain management techniques and emotional support (Patel et al., 2021;Scarciglia et al., 2023).

Policy approaches to mitigate the impact of air/water/food pollution and related diseases
Preventive measures for climate crisis-related pollution involve policy implementation, public awareness and quality monitoring (Eskander and Fankhauser, 2020).Canada utilizes various policies to address air pollution (Government of Canada, 2020;Newell, 2021), including carbon pricing, subsidies for cleaner technologies and emission standards enforcement.Vegetation plays a crucial role in pollutant removal and reducing respiratory issues.Moreover, regular food inspection systems and enforcing regulations are also crucial to ensure compliance with hygiene and safety standards (Barnes et al., 2022).
Preparedness measures encompass environmental education and health risk awareness.Healthcare professionals play a crucial role in foodborne illness awareness education on air pollution.Early warning systems should notify older adults of elevated pollution levels, especially during heat waves when ground-level ozone production intensifies.These alerts should include guidance on protective measures.Additionally, community support networks are vital for disseminating information and resources, bolstering resilience and protecting the health of older adults (Kendall et al., 2006;Radisic and Newbold, 2015;Karataş and Karataş, 2016).
Effective responses rely on timely air and water quality communication.The Public Health Agency of Canada uses environmental data to prevent gastrointestinal illnesses (Moffat and Struck, 2011).Investments in water systems and operator training have reduced waterborne diseases.Strengthening surveillance systems and research on mitigation measures are recommended (Smith and Fazil, 2019).
The effective recovery from pollution-related diseases relies on established health monitoring systems for timely risk identification and intervention, emphasizing regular checkups and assessments.Moreover, an inclusive recovery policy should cover physical well-being, offering resources and assistance such as rehabilitation programs for lingering effects or disabilities from pollution-related diseases.Mental health support is equally crucial due to its documented negative impact on mental well-being (Ramadan and Ataallah, 2021).

A FRAMEWORK FOR ACTION: PROMOTING ELDERLY HEALTH PRACTICES
Disaster risk management in Canada takes place at federal, provincial, territorial and municipal levels.However, there is a lack of focus on addressing the specific needs of older adults.Our review has identified strategies to improve the health of older adults in the face of climate crisis risks (Figure 2).It is essential to carefully consider the challenges faced by older adults when adapting to these risks.

Robust risk metrics and assessment
The diverse impacts of the climate crisis on the elderly, coupled with budget constraints for risk response, call for robust risk assessments by health policymakers.This should include sensitivity analysis, stress testing, scenario analysis and consideration of extreme events.However, current Canadian research predominantly centers on heat waves, overlooking other climate-related disasters like floods and wildfires.The inadequate response to the 2013 Alberta floods and the air pollution from the 2023 Nova Scotia wildfires underscores the necessity for holistic risk management.To enhance resilience, Canadian organizations and policymakers should implement advanced early warning systems and emergency preparedness protocols, incorporating cutting-edge technologies, real-time monitoring (e.g.smartphone apps) and community notification systems.

Root cause analysis to design tailored policies
Root cause analysis (RCA) plays a crucial role in developing tailored strategies for addressing climate change disasters, from reducing heat wave fatalities to managing wildfires in Canada.Despite advancements in heat wave prediction, the elderly in Canada remain highly vulnerable, with a severe heat wave in June 2021 causing 570 deaths in British Columbia, with 79% aged 65 or older (CBC News, 2021).RCA can identify key predisaster mitigation approaches by addressing the root causes of these impacts.For instance, if mortality is linked to a lack of cooling systems, the root cause may be seniors' fixed incomes and rising costs.Government subsidies like funding or tax credits can promote energyefficient cooling technologies and advocate for responsible air conditioning practices.Additionally, increasing green spaces in low-income neighborhoods can reduce heat risks, as wealthier areas typically have more green spaces.Implementing these measures improves access to cooling solutions and enhances urban environments, ultimately reducing heat-related fatalities.
RCA is crucial for addressing Canada's increasing wildfires, exceeding the decade average by 20% (Cecco, 2023).RCA may reveal that wildfire origins extend beyond high temperatures, often involving human actions like deforestation and arson.Tailored mitigation can then be implemented, reallocating resources from firefighting to prevention efforts like controlled burns and public education.

Targeted financial support
While increased financial support to mitigate climate impacts is crucial, it must effectively address the unique needs of the elderly, considering their health disparities.The 'Canadian Climate Incentive' exemplifies such initiatives; however, they often overlook climate justice and health inequalities, necessitating the inclusion of equity and human rights at the core of decision-making and action on climate change.Recent practices show that targeted financial support can improve climate justice, benefiting vulnerable populations, including children, older adults and people with disabilities or preexisting health conditions (EPA, 2023a).Another example involves addressing the concerns of local low-income BIPOC (Black, Indigenous and People of Color) communities, who face increasing risks from climateexacerbated urban heat islands and coastal and inland flooding (EPA, 2023b).The research, funded by the US Environmental Protection Agency (EPA), aims to prioritize these concerns and propose climate resilience solutions, emphasizing the associated health benefits.Thus, while broad financial support is essential, focused initiatives tailored to older adults' specific needs should be considered to improve equity and human rights, thereby having a more significant impact on mitigating climate risks for the vulnerable population.

Vulnerability mapping with geographic information
Vulnerability mapping provides critical spatial data that decision support tools use to enhance risk management for climate change disasters in Canada by pinpointing high-risk areas for older adults and guiding targeted interventions.It is particularly valuable in coastal regions, like the Atlantic coast and the Beaufort Sea, for addressing flooding risks and planning evacuations.In heat wave-prone areas, like the south, it identifies neighborhoods lacking cooling resources, enabling cooling centers and fan distribution.Despite progress in Toronto and southern Quebec, provinces like Nova Scotia, British Columbia and Alberta should adopt such methods, exemplified by the 2023 Nova Scotia wildfires (Nova Scotia, 2023).Vulnerability mapping also addresses indirect impacts like VBDs, considering climate, population and environmental factors.This aids in identifying vulnerable areas for interventions such as mosquito control and awareness campaigns.Overall, vulnerability mapping is vital in reducing disease transmission risks associated with the climate crisis.

Promoting awareness
Raising climate crisis awareness among older adults through media and the internet has limited effectiveness for those with dementia or limited computer skills.In Canada, there's a shortage of guidelines for disaster preparedness in older adults.Research shows that many older adults lack emergency plans and preparedness information (Al-Rousan et al., 2014).Despite available resources, a survey of 1304 older adults found that two-thirds lacked an emergency plan, had no disaster preparedness education, and were unaware of relevant resources.Over a third lacked essential supplies like food and water.These findings underscore the need to address these challenges and enhance awareness and preparedness among older adults, considering their limitations and ensuring accessible information and resources.

Empowering physicians: a pathway to climate-resilient healthcare system
Training Canadian physicians to address climaterelated health challenges is crucial for improving public health and eco-health literacy (Hackett et al., 2020).The Canadian Association of Physicians for the Environment [CAPE (https://cape.ca)]plays a vital role in this regard, understanding the environmental impact on human health.Through educational initiatives, including an eight-module toolkit, CAPE empowers healthcare professionals and students to advocate for climate change policies (Patrick et al., 2012;Perrotta, 2019).These efforts enable physicians to drive policy changes, engage communities, and enhance public awareness, contributing to a robust response to the climate crisis and reinforcing healthcare system resilience.For instance, CAPE advises heat response activities to protect health, including educating the public on protective measures, monitoring vulnerable populations and subsidizing improvements in the energy efficiency of housing for the elderly to reduce the pathological effects of energy poverty associated with increased incidence of respiratory problems and mental stress.Physicians can also aid research on climate crisis health impacts and response strategy effectiveness, informing evidence-based practices (Catford, 2008).They can improve patient outcomes, develop climate-sensitive treatment protocols and promote sustainable healthcare.Integrating climate crisis considerations enhances healthcare system resilience.

Benchmarking: insights from collaborations
Collaborative efforts and benchmarking are essential for evidence-based climate crisis disaster management.They offer valuable insights, encourage knowledge sharing and support continuous improvement.Through benchmarking, we can evaluate response efforts, comparing factors like response times, coordination mechanisms, resource allocation and communication strategies across regions or organizations to identify areas for improvement.Similarly, benchmarking assesses preparedness by comparing emergency response plans, resource allocation, training programs and infrastructure, allowing for weaknesses to be identified and mitigation measures enhanced.An example of successful collaboration is the UK's multi-institutional research program involving 14 universities, which developed a decision-based tool for extreme weather events (O'Neill et al., 2009).Similar approaches can be applied in Canada, creating region-specific decision-based tools that integrate scientific knowledge and data-driven approaches to manage climate crisis disasters effectively.

CONCLUSION
The climate crisis significantly impacts older adults in Canada, necessitating immediate action.This study reviews current strategies to mitigate direct and indirect effects on elderly health.These include enhancing early warning systems, healthcare infrastructure, urban planning, social support and community engagement.Tailored approaches involve relocating older adults during heat waves, ensuring flood resilience, managing drought-related water supply issues and proactive wildfire evacuation plans.The importance of medical emergency protocols and communication plans to address indirect impacts like VBDs is identified.
To enhance risk response plans, we propose several key actions.First, prioritize the establishment of robust risk metrics, including sensitivity, stress, scenario and extreme event analyses, to anticipate and manage unexpected climate change disasters effectively.Second, utilize root cause analysis to deepen understanding of underlying causes, followed by targeted financial support to tailor risk response strategies.Third, employ vulnerability mapping, using geographic data, to pinpoint areas where older adults are most vulnerable, facilitating targeted interventions and resource allocation.Promote awareness and preparedness among older adults, considering their unique limitations.Empower physicians with climate crisis training to advocate for policy changes and community engagement.Lastly, benchmarking with successful initiatives to inform evidence-based climate change disaster management approaches.

Fig. 1 :
Fig. 1: Health inequalities and impacts of climate crisis on elderly.

Fig. 2 :
Fig. 2: Policy recommendations for climate crisis impacts across four key risk management pillars.

Table 1 :
Risk management actions associated with direct and indirect impacts of climate crisis